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After defending the Affordable Care Act in all its intricacies for six years, President Obama proposed ways to improve it on Monday, saying that Congress should provide larger subsidies for private health insurance and create a public plan like Medicare to compete with private insurers in some states. At the same time, he accused the pharmaceutical industry of trying to protect its profits by opposing any constraints on drug prices. Mr. Obama offered his views in a valedictory message summarizing what he sees as his legacy on health care, together with his ideas to improve the Affordable Care Act. (Pear, 7/11)

President Barack Obama Monday called on Congress to revisit the controversial idea of providing a government-run insurance plan as part of the offerings under the Affordable Care Act. The so-called “public option” was jettisoned from the health law by a handful of conservative Democrats in the Senate in 2009. Every Democrat’s vote was needed to pass the bill in the face of unanimous Republican opposition. But in a “special communication” article published on the website of the Journal of the American Medical Association, the president said a lack of insurance plan competition in some areas may warrant a new look. (Rovner, 7/11)

Obama's assessment of the Affordable Care Act comes in an eight-page article in the Journal of the American Medical Association, a peer-reviewed publication. The article debuted Monday on the journal's website, and Obama plans to echo the themes in public events and speeches in the coming weeks. (Lederman and Alonso-Zaldivar, 7/11)

Drawing on a wide range of evidence, Obama states his major, unsurprising findings: 20 million people have gained insurance, bringing the uninsured rate to 9.1 percent in 2015. He notes an increase in the number of non-elderly people who have a physician and access to medicine. He cites a study that found people who gained coverage through expanded Medicaid have greater financial security, reducing the debts sent to collection by $600 to $1,000. His most controversial argument is probably this: He credits the law with helping to control health care spending, a point that has been much debated. It's unclear how much of the slowdown in the growth of health care spending is due to the Great Recession and how much should be attributed to the law or other factors. (Johnson, 7/11)

“The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965,” he wrote. “Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges.” (Radnofsky, 7/11)

But Obama also panned congressional Republicans for “hyperpartisanship” which he claims has kept the law from having a greater effect. “Through inadequate funding, opposition to routine technical corrections, excessive oversight, and relentless litigation, Republicans undermined ACA implementation efforts,” Obama wrote. “We could have covered more ground more quickly with cooperation rather than obstruction.” (Bennett, 7/11)

Obama argued that the public option would bring much-needed competition in markets where only one or two plans sell coverage – areas accounting for 12 percent of Obamacare customers. Obamacare tried to create more competition through federal loans to create insurance co-ops, but 15 of the 23 co-ops supported by the law have failed. Besides the public option, Obama offered other prescriptions for making health care more affordable. Obama urged Congress to offer even more generous assistance to middle class families paying for premiums on the law’s insurance marketplaces – many who qualify for subsidies say they still can’t afford to pay for coverage. (Wheaton, 7/11)

It’s a shift that reflects how the party has tilted leftward during the Obama years. Hillary Clinton emphasized a public option in an announcement Saturday that was interpreted as a play for supporters of Sen. Bernie Sanders (I-Vt.), who ran a surprisingly strong campaign against her for the Democratic presidential nomination. Sanders has pushed even further for a government-run, “single-payer” system. A public option has no real chance of passing Congress, at least with Republicans in charge of the House. (Sullivan, 7/11)

Hillary Clinton updated her health policy agenda over the weekend to include more strongly worded support for a public option insurance plan on the Obamacare exchanges. Although her position is consistent with what she’s supported in the past, it’s probably not coincidental that the announcement follows a series of bad news about co-op failures and insurers leaving exchanges. These departures have thrown the viability and affordability of exchanges into question. (Owens, 7/11)

Tucked within a lengthy essay he wrote to defend the Affordable Care Act, Obama chastised drug makers for their stance on pharmaceutical pricing and challenged the companies to renew their commitment to improving public health. After lambasting Congress for refusing to work with him to more quickly to provide health coverage, he singled out drug makers as another example of obstinacy. “The pharmaceutical industry oppose(d) any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits,” he wrote in an essay in the Journal of the American Medical Association that appeared Monday. (Silverman, 7/11)

Describing work needed to improve the health law, Obama wrote that drug costs “remain a concern,” citing a 12 percent increase in prescription drug spending in 2014. He called for legislation to increase rebates drug manufacturers are required to provide to Medicaid and Medicare and to grant more authority to the federal government to negotiate prices on high-cost drugs. (Dorning, 7/11)

In this Special Communication, I assess the progress the ACA has made toward improving the US health care system and discuss how policy makers can build on that progress in the years ahead. I close with reflections on what my administration’s experience with the ACA can teach about the potential for positive change in health policy in particular and public policy generally. (Obama, 7/11)